The goal of world kidney day is to raise awareness of kidney diseases worldwide. The theme for this year’s kidney day is ‘Kidney diseases and children – Act early to prevent it’. There are millions of people worldwide affected by kidney problems and children are not immune against them. In fact, the early onset of kidney diseases in children make them more prone to growth and developmental abnormalities. The widespread use of ultrasound scan in pregnancy has helped in identifying structural kidney problems which help in early intervention to correct the defect. Kidney diseases affecting the child are more likely due to congenital malformations of the urinary system. They may be born with smaller than normal kidneys or abnormally shaped. They may have a problem with the urinary valves which lead to obstruction of the urine flow and permanent damage to the kidneys. These may be a reason for recurrent childhood infections which may persist despite multiple antibiotic courses.
Nephrotic syndrome: This is one of the common childhood kidney problems. Here, the child presents with swelling all over the body due to low blood proteins which have leaked through the urine. If not detected and treated on time could lead to complications like severe infections, early hypertension and clotting of blood vessels.
Acute kidney failure: In this condition there is a drop in the urine volume along with retention of toxic waste products in the blood. In children a common cause of acute kidney failure is acute glomerulonephritis. The child may complain of discoloration of urine along with body swelling and high blood pressure. Hemolytic uremic syndrome (HUS) is another cause of acute kidney failure in children which can progress to dialysis.
Kidney stones: They are an important problem in children. Most of the stone diseases in children are inherited. They may be associated with problems of genetic inborn metabolism of certain amino acids or due to a disorder of kidney tubule functions. These children develop multiple stones in both kidneys and urinary bladder which may need to be removed surgically. Identifying the problems early help to make changes in the diet and fortify essential nutrients and salts to neutralize the long term ill effects.
The worrying trend is a recent shift in the incidence of acquired stone disease in children. Traditionally, women and children were at lower risk for kidney stones. Due to changes in the dietary habits – increased salt intake, more processed food, decreased fibre diet and sugary beverages have increased the incidence of stones in this low risk group. Several studies done in the Middle East countries have shown an increase in the incidence of stones especially among women and children. Higher intake of processed food has depleted our natural stone preventing mechanism. The typical diet rich in phosphate include foods like meat and poultry. Reduced intake of fluids also increases the risk for kidney stones.
Chronic kidney disease: This is a condition were there is a structural or an abnormal kidney test which persists for more than three months despite treatment. The severity of the condition is assessed using the glomerular filtration rate (GFR) which tells us the risk of anticipated complications in the future. Children with chronic kidney disease during the growth period are likely to have deformities like short stature, renal rickets and poor dentition. This happens due to decreased Vitamin D production as well as loss of essential bone minerals through the urine. They can develop anemia and hypertension which may need medications to correct.
Some of these children may progress to end stage kidney failure which may require dialysis or kidney transplantation. This may not only affect their growth, but may disrupt their education, social life and lead to low self-esteem.
Early detection helps in planning corrective surgery, make dietary changes, add important nutritional supplements and medicines which help in alleviating the long term complications of kidney disease. Eating healthy not only helps in preventing complications but also reduce the risk of developing stone disease in children.
Dr.John Cherian Verghese
Aster Hospital and Clinics